Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterioronly Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review

Abstract

The aim of this systematic review was to evaluate the surgical, radiological, and functional outcomes of posterior-only versus combined anterior-posterior approaches in patients with traumatic thoracolumbar burst fractures. The ideal approach (anterior-only, posterior-only, or combined anterior-posterior) for the surgical management of thoracolumbar burst fracture remains controversial, with each approach having its advantages and disadvantages. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed (registration no., CRD42018115120). The authors reviewed comparative studies evaluating posterior-only approach compared with combined anterior-posterior approaches with respect to clinical, surgical, radiographic, and functional outcome measures. Five retrospective cohort studies were included. Postoperative neurological deterioration was not reported in either group. Operative time, estimated blood loss, and postoperative length of stay were increased among patients in the combined anterior-posterior group in one study and equivalent between groups in another study. No significant difference was observed between the two approaches with regards to long-term postoperative Cobb angle (mean difference, −0.2; 95% confidence interval, −5.2 to 4.8; <i>p</i> =0.936). Moreover, no significant difference in functional patient outcomes was observed in the 36item Short-Form Health Survey, Visual Analog Scale, and return-to-work rates between the two groups. The available evidence does not indicate improved clinical, radiologic (including kyphotic deformity), and functional outcomes in the combined anterior-posterior and posterior-only approaches in the management of traumatic thoracolumbar burst fractures. Further studies are required to ascertain if a subset of patients will benefit from a combined anterior-posterior approach.

Treatment Strategy for Impending Instability in Spinal Metastases

“…There seemed to be an inevitable difference in deciding a treatment. 24) There are some limitations in this study. First, the cohort of this study was heterogeneous, and analysis was difficult as the patients had different tumor types and prognoses, and thus in the follow-up period, the patients were managed by various treatment plans.…”

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“…Several factors should be evaluated: the injury pattern, the presence of neurologic deficit, the patient’s medical condition, and the operator’s surgical skill [ 46 ]. Several studies have reported their use of MISS for the treatment of unstable thoracolumbar fracture with or without spinal cord injury; flexion- and extension-distraction injuries; and complex sacral fractures [ 46 - 49 ]. Although the necessity of spinal fusion for the treatment of spinal trauma is still controversial, fixation without fusion is considered to be effective in providing stability and sagittal balance for the treatment of thoracolumbar burst fractures without neurologic deficit.…”